The role of HM Coroner or Procurator Fiscal Service in organ donation

A third of deaths are referred to HM Coroner in England, Wales and Northern Ireland and a quarter of deaths to the Procurator Fiscal (PF) Service in Scotland.

Deaths where the cause is unknown or unnatural (for example, related to an accident, violence or neglect) or where the deceased died in state detention such as in prison, or whilst under a section of the Mental Health Act, are required to be referred.

When a death is reported, the coroner or PF establishes the identity of the person who has died and how, when, and where they died. They decide if further investigation is required and try to use the findings to help prevent future deaths.

On this page:

• Decisions made by the coroner or PF
• How can NHSBT support a complex judicial decision?
• Structure of coroner and PF authorities in the UK
• Proforma for coroner referrals
• Guidance for coroners and PFs

Decisions made by the coroner or PF

When organ or tissue donation is possible, specialist nurses in organ donation or tissue donation work closely with the donor's family to explore the deceased's donation decision. The specialist nurse will also collaborate with the coroner or PF, or their officer.

If a death meets the criteria for coronial or PF referral, the coroner or PF must confirm that donation will not interfere with their legal duties. This collaboration often happens through the coroner or PF’s officer. Outside of the coroner or PF’s normal working hours, local police can help make contact.

Organs and tissues cannot be offered to transplant recipients or surgically retrieved until the coroner or PF's lack of objection has been confirmed.

To protect the investigation, the coroner or PF may limit which organs can be retrieved. In complex cases, a Home Office pathologist or other relevant judicial agencies may also be consulted.

When approached to support donation, a coroner or PF may issue one of the following decisions:

• full lack of objection: no restriction is placed on organ and/or tissue retrieval
• partial (restricted) objection decision: only some and not all requested organs and tissues can be retrieved
• full objection decision: organ and tissue retrieval cannot proceed

'Lack of objection' agreements for eye donation

Some coroner jurisdictions in England have a blanket 'lack of objection' agreement for eye donation in all deaths, except where a forensic postmortem is required – for example, suspected criminality, medicolegal concerns, or deaths in custody.

This approach reduces unnecessary communication with NHS Blood and Transplant (NHSBT), prevents loss of potential eye donors, and minimises out-of-hours disruption for on-call coroners.

How can NHSBT support a complex judicial decision?

Specialist nurses can work with intensive care teams to support the judicial process. There are a number of options which may help the coroner to reach a full or partial lack of objection decision.

These include:

• using existing radiological imaging records or body mapping documentation completed by the specialist nursing team (for example, a trauma series CT scan)
• requesting a pathologist attends donor critical care and/or the donor theatre to witness organ or tissue retrieval surgery
• organising the retention of blood samples for any investigation
• requesting evidential statements from retrieval surgeons
• liaising with the police and pathologist to commence forensic investigation before organ and tissue retrieval
• participating remotely in a multi-agency video conference meeting, to support communication between all agencies and the final coroner or PF decision
• assisting in collating medical records for the coroner or PF and pathologist
• seeking expert medical opinions from the donor hospital at request 

NHSBT provides an annual coroner/procurator fiscal report to demonstrate judicial collaboration in the annual deceased organ donation activity.

Structure of coroner and PF authorities in the UK

 The structure of coroner and PF services varies across different parts of the UK.

Proforma for coroner referrals

NHSBT implemented a pilot project in collaboration with HM Coroner to evaluate a standardised coroner referral proforma (FRM7248).

The proforma aims to streamline communication and decision-making across multiple regions, reducing the delays and confusion caused by varying practices and documentation.

It allows coroners to clearly indicate their decision regarding organ and tissue donation, including detailed permissions in the event of a partial (restricted) objection.

The pilot proforma review paper outlines the objectives, pilot design and implementation, as well as the expected outcomes, recommendations and conclusions based on feedback.

Following its success, the proforma is now available for wider use in coronial jurisdictions within England, Wales and Northern Ireland.

• Read the coroner referral proforma pilot review paper (PDF 465KB)
• View an example of the coroner referral proforma (PDF 1,965KB)

Guidance for coroners and PFs

The Chief Coroner has issued guidance for organ and tissue donation to help coroners with decision-making in situations that involve organ and tissue donation:

Chief Coroner’s Guidance No. 26 Organ and Tissue Donation – Courts and Tribunals Judiciary

For the Procurator Fiscal Service, the Scottish Government has published the following agreement to support timely decision making in donation:

Agreement between the Crown Office and Procurator Fiscal Service and the Scottish Donation and Transplant Group In regard to Organ and Tissue Donation

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